Abstract: Hypertension is prevalent in African Americans and it is associated with three chronic diseases namely; stroke, kidney disease, and heart disease. The literature examines the prevalence of hypertension in African Americans in relation to other groups. Not only do African Americans have higher rates of organ damage, but also stroke and heart disease mortality caused, at least in part, by hypertension. Health professionals, especially nurses, should be proactive in detecting hypertension in African Americans and be more aggressive in controlling and treating this high-risk group. Health education regarding the dangers of hypertension should be the primary focus of healthcare professionals to decrease and prevent mortality and morbidity in the African Americans with hypertension.
Key Words: Hypertension, High Blood Pressure, African Americans, Blacks
Prevalence of Hypertension
An estimated 50 million people in the United States (U.S.) suffer from hypertension (He, Munter, Chen, Roccella, Streiffer, & Whelton, 2002). However, the prevalence of the disease seems to be greater especially in African Americans than Whites, in the U.S. "The incidence and prevalence of hypertension in the U.S. are about 1.5 - 2.0 greater in African Americans than in the White population" (Vaughn & Denlanty 2000, p. 411). Curtis, James, Raghunathan, & Alcser (1997) concluded in a National Health and Nutrition Examination that the age adjusted prevalence of hypertension in African Americans is about 34% males and 31% females; while in non-Hispanic Whites it is 25.4% male and 21% female.
The exact prevalence of hypertension in African Americans is said to be dependent on definition. For instance, in the United Kingdom (UK), hypertension is defined as having a blood pressure reading of 160/100 mmHg. In North America, however, two clinical readings of 140/90 mmHg or greater indicate hypertension. Nevertheless, a recent research study showed hypertension is "least... diagnosed, treated, and controlled" among "young black men < than 50 years of age" (Hill, Bone, Hilton, Roary, Kelen, & Levine, 1999 p. 548). The findings are consistent with Livingston (1993); and Morisky, Lees, Sharif, Liu, & Ward (2002) also found hypertension to be poorly treated in Blacks. Livingston (1993) further stated that Black Americans' socioeconomic status is generally poorer. As a result, effective treatment of their hypertension is inhibited by various socioeconomic related and psychological factors, such as access to medical care, cost of treatment and educational deficits.
African Americans often do not seek treatment for hypertension until there is considerable target organ damage (Cohn, Hall, Fagan, Prisant, Mansoor, & White, 1998). This segment has more blood pressure related target organ damage compared to Caucasians; a 1.5 fold higher risk of stroke; 1.5 fold greater risk of heart disease mortality (even when accounting for socioeconomic status); a greater prevalence of left ventricular hypertrophy; and a six fold greater risk of end-stage renal disease related to hypertension (James, Clarke, Curry, Douglas, & Francis, 1997).
Not only do African Americans have higher rates of organ damage, but also of stroke and heart disease mortality caused, at least in part, by hypertension. "African Americans have an 80% higher rate of stroke mortality, 50% higher rated of heart disease mortality and a 320% greater rate of hypertension - related end - stage renal disease (Ferdinand, 2000 p. 541). Hypertension is called the "silent killer" (Rabkin, 1986) because if often goes undetected and causes many diseases.
This paper will focus on the following diseases in relation to African Americans with hypertension: stroke, kidney disease, and heart disease. The terms African American and Blacks will be used interchangeably as will hypertension and high blood pressure because studies refer to both. …